Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 048634 | GA |
NPI | 1114979242 |
---|---|
Provider Name | Jean Marc Guitton |
First Address | Augusta, GA 30917-4630 |
Second Address | Augusta, GA 30907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 20/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000885596D | (05) | GA |
000885596E | (05) | GA |
G48634 | (05) | SC |
H20250 | (02) | GA |
P00393603 | RAILROAD MEDICARE (01) | GA |